In the area of worker's compensation claims, no innovation or technology has replaced the traditional method of adjusters calling vendors that manage the approval, delivery and scheduling process for durable medical equipment needed for patients covered by worker's compensation insurance. The adjuster typically calls for a quotation related to their injured worker's needs, and the vendor spends time calling suppliers of durable medical equipment to fill the adjusters' requests, and then the vendor contacts the adjuster with one or more quotations for supplying the requested item(s). If one of the suppliers can provide the device sooner than the others, then this may be more important than the usually small difference in costs between the various suppliers. Typically an adjuster receives a very small subset of options from one vendor, and relies on other vendors for a cost comparison and to fill all of the items needed for a single patient and a single injury or illness.
The applicant has identified certain deficiencies in the current system that affects the efficiency of the system for payers, adjusters and providers. The system has no paper trail for the approval of orders filled by providers after receiving calls from adjusters. Payers, which include the state, through a state worker's compensation fund, the insurance company and the employer, have no way of tracking approvals and deliveries of items to the patient/claimant, due to a lack of a paper trail. Approvals and payment for items supplied by the providers are often delayed or require multiple submissions to correct errors in paperwork created and submitted after the items have already been delivered to the patient. This increases overhead costs to providers, which are reflected in prices charged for items provided. These costs are passed on to employers through higher cost for self insured employers or higher employer's premiums paid into the system.
There has been and remains no incentive within the system to innovate or to apply technology to increase the efficiency of filling insurance adjusters' requests.